Cognitive flexibility and empathy after frontal lobe lesion

Although impairments in interpersonal behavior and cognitive flexibility are frequently associated with frontal lobe injury, the relationship between these deficits remains unknown. Social theories have emphasized the importance of flexible thinking for high-level social functioning, including perspective-taking capacities and empathy. We hypothesized that a positive correlation between measures of cognitive flexibility and empathy would be apparent after frontal lobe lesions in the dorsolateral, mesial or orbital sectors and possibly in a diverse group with frontal lobe damage. To test this hypothesis, 40 subjects with frontal or nonfrontal lobe lesions were compared on standardized measures of cognitive flexibility and empathy. Both groups showed similar quantitative alterations on the empathy measure, but responses of the frontal lesion group related these to greater discomfort in changing, novel, or ambiguous situations, while responses of the nonfrontal lesion group indicated reduced social self-confidence. Cognitive flexibility and empathy levels showed a similar pattern of variation in the nonfrontal lesion group, but not in the frontal lesion group because of marked differences among frontal lesion subgroups. Left and right dorsolateral lesions affected both cognitive flexibility and empathy (with a positive correlation after left dorsolateral lesions), while orbital lesions profoundly affected empathy only, and mesial lesions affected cognitive flexibility only. The findings support a model of functional-anatomic distinctions within the frontal lobe that encompasses cognitive and noncognitive mechanisms within a network of cerebral structures subserving complex social processes.